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Levrat V, Favre S, Richard-Lepouriel H. Current practices of psychoeducation interventions with persons with bipolar disorders: a literature review. Front Psychiatry 2024; 14:1320654. [PMID: 38250257 PMCID: PMC10797008 DOI: 10.3389/fpsyt.2023.1320654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
This review sought to summarize the literature on current practices and forms of psychoeducation in the management of patients with bipolar disorder (BD), including only randomized controlled trials to ensure the best level of evidence. An extensive review of the available literature was conducted using PubMed/MEDLINE, Embase, and PsychInfo databases from inception to April 28th, 2022. The search yielded 381 studies. Seventy articles were included after removing duplicates and applying the inclusion/exclusion criteria. A best-evidence synthesis was used to identify the key results of each study and summarize the outcomes. Eleven descriptive categories were made. They encompass different forms of psychoeducation compared or combined with other psychosocial interventions, varying in setting (individual or group), with or without family members, structured or unstructured, mediated or not by digital tools (smartphone, internet). Globally, these studies show that psychoeducation is important in the treatment of BD, as it leads to a decrease in relapses, mood episodes, hospitalizations, and improved functioning or quality of life. Some studies also showed the benefits of psychoeducation on the patient's level of knowledge of pharmacological treatment and the disorder or compliance with medication, as well as reduced self-stigma. The limitations of this review are linked to the selection of only RCTs and the reliance on their post-hoc analyses. This review confirms the benefit of psychoeducation and psychosocial interventions on the evolution of BD (in different outcomes, including quality of life, relapse, and rehospitalization rates, for example). More recent interventions, such as mindfulness or online psychoeducation, represent an interesting option but more evidence is needed.
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Affiliation(s)
- Vanessa Levrat
- Mood Disorder and Anxiety Unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
| | - Sophie Favre
- Mood Disorder and Anxiety Unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Mood Disorder and Anxiety Unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Nierenberg AA, Agustini B, Köhler-Forsberg O, Cusin C, Katz D, Sylvia LG, Peters A, Berk M. Diagnosis and Treatment of Bipolar Disorder: A Review. JAMA 2023; 330:1370-1380. [PMID: 37815563 DOI: 10.1001/jama.2023.18588] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Importance Bipolar disorder affects approximately 8 million adults in the US and approximately 40 million individuals worldwide. Observations Bipolar disorder is characterized by recurrent episodes of depression and mania or hypomania. Bipolar depressive episodes are similar to major depressive episodes. Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods. The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation. Approximately 75% of symptomatic time consists of depressive episodes or symptoms. Early diagnosis and treatment are associated with a more favorable prognosis. Diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode. Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine. Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain. Antidepressants are not recommended as monotherapy. More than 50% of patients with bipolar disorder are not adherent to treatment. Life expectancy is reduced by approximately 12 to 14 years in people with bipolar disorder, with a 1.6-fold to 2-fold increase in cardiovascular mortality occurring a mean of 17 years earlier compared with the general population. Prevalence rates of metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%) are higher among people with bipolar disorder, contributing to the risk of early mortality. The annual suicide rate is approximately 0.9% among individuals with bipolar disorder, compared with 0.014% in the general population. Approximately 15% to 20% of people with bipolar disorder die by suicide. Conclusions and Relevance Bipolar disorder affects approximately 8 million adults in the US. First-line therapy includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine.
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Affiliation(s)
- Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Bruno Agustini
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Ole Köhler-Forsberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Department for Affective Disorder, Aarhus University Hospital, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Cristina Cusin
- Harvard Medical School, Boston, Massachusetts
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston
| | - Douglas Katz
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Louisa G Sylvia
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Amy Peters
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Barbeito S, Vega P, Ruiz de Azúa S, González-Ortega I, Alberich S, González-Pinto A. Two-year evaluation of a multifamily psychoeducational program (PROTEC) in the family burden and prognosis of bipolar patients. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:225-234. [PMID: 34284154 DOI: 10.1016/j.rpsm.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bipolar disorder causes a significant burden on the lives of patients and their families. The family is one of the targets for therapeutic intervention, related to the prognosis in patients with bipolar disorder. AIM To assess the effectiveness of a multifamily psychoeducational program for people with bipolar disorder, in the family burden: objective and subjective and in the variables related to the course of the patients with bipolar disorder (symptoms, adherence, functionality, hospitalizations), comparing it with a control group (CG). MATERIALS AND METHODS A total of 148 relatives of bipolar patients and 148 bipolar patients were recruited. The sample was randomized (experimental group [EG] and CG) and with single-blind evaluations (baseline, at 5 months and one year). Clinical and sociodemographic variables were collected from families and patients (family burden self-report scale, Strauss-Carpenter Scale, Global Assessment of Functioning, Morisky Green adherence Scale). Both, EG and CG received 8 multifamily sessions, applied exclusively on the relatives of patients with bipolar disorder, but in the EG a psychoeducational treatment was carried out and in the CG only playful and current topics were discussed. Bivariate and logistic regression models were used, among others. RESULTS The caregivers and patients of the EG and CG did not differ in any of the baseline variables (sociodemographic and clinical) (P>.001). In the total sample, the baseline objective burden was light (mean 0.6±0.4) and the subjective ones was medium-moderate (mean 1.1±0.3). During the follow-up, in relation to the variables of the caregivers, there was a greater reduction in the objective burden in the EG compared to the CG (5 months P=.006; one year P=.002). It was found that the objective burden (P=.006) and the subjective burden (P=.003) were significantly reduced over a year in EG but not in the CG. During the follow-up, the patients whose caregivers belonged to the EG showed a greater increase in the frequency of social activity (P=.008), in the work activity (P=.002), and global functioning (P=.002), and reduced their symptoms (P≤.001). Longitudinal analyses, over a year, showed that patients in the EG had a greater improvement in functionality compared to patients in the CG (P=.001). After the intervention, adherence to pharmacological treatment improved more in EG than in the CG (P≤.001). Regarding hospitalizations, any patients in the CG were hospitalized during the 5 months after the intervention, while 27.8% of the patients in the CG were hospitalized (P≤.001); the difference between groups remained significant in the long term (one year: P≤.001; 2 years: P≤.001). There were no significant differences between groups in the pharmacological treatment of the patients in any of the evaluations. CONCLUSIONS The multifamily psychoeducational intervention group improved the family burden after the intervention. Likewise, bipolar patients, whose families attended the EG, improved significantly, over a year, the functionality, the frequency of social contacts, the work status, the adherence to treatment, and reduced their symptoms. In addition, in the EG, the percentage of hospitalizations during the 2 years of follow-up was significantly reduced.
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Affiliation(s)
- Sara Barbeito
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja (UNIR), Logroño, La Rioja, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) G10, Vitoria-Gasteiz, Álava, España.
| | - Patricia Vega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) G10, Vitoria-Gasteiz, Álava, España; Universidad del País Vasco, Leioa, Bizkaia, España; Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
| | | | - Itxaso González-Ortega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) G10, Vitoria-Gasteiz, Álava, España; Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
| | - Susana Alberich
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) G10, Vitoria-Gasteiz, Álava, España; Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) G10, Vitoria-Gasteiz, Álava, España; Universidad del País Vasco, Leioa, Bizkaia, España; Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
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Vasava T, Majhi G, Muralidhar D, Kumar D. Factors Associated with Family Retention or Involvement in Treatment of Persons with Severe Mental Illness: A Scoping Review. Indian J Psychol Med 2023; 45:331-337. [PMID: 37483579 PMCID: PMC10357914 DOI: 10.1177/02537176231164647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Objective A scoping review was conducted to detect the factors that affect family retention (FR) or involvement (FI) in the treatment of persons with severe mental illness (PwSMI) and to understand the gaps in this research area. Design We included studies that described factors associated with FR/FI in the treatment of persons with PwSMI. English language articles available in full text, published until June 2022, were included. The literature search was carried out in four major electronic databases, such as PubMed, Scopus, ProQuest, and EBSCOhost, for 6 months from January 2022 to June 2022, which yielded 5442 articles, of which six (four primary studies and two secondary studies) were considered for the final scoping review as per the inclusion criteria. Results Five major categories of factors were identified: (a) family level, (b) professional level, (c) mental health system level, (d) related to characteristics of the patient and illness, and (e) related to the external environment. Most studies described barriers to FI, while only a few elaborated on facilitators for FI/FR. Systemic and family-level factors were the major contributors to the barrier to FI and FR in the treatment of people with PwSMI. Conclusion There is a dearth of literature in the field of FR/FI in the treatment of people with schizophrenia. More research is required so that holistic interventions can be designed and provided.
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Affiliation(s)
- Tejas Vasava
- Dept. of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - Gobinda Majhi
- Dept. of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - D. Muralidhar
- Dept. of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - Devvarta Kumar
- Dept. of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
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[Evidence-based inpatient psychotherapy of bipolar disorders]. DER NERVENARZT 2023; 94:198-205. [PMID: 36735036 DOI: 10.1007/s00115-022-01432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although psychotherapy is an important pillar in the treatment of bipolar disorders, alongside pharmacotherapy, non-drug and complementary procedures, there is no up to date evidence synthesis for inpatient psychotherapeutic treatment and work with caregivers. OBJECTIVE To review and evaluate the current study situation on evidence-based inpatient psychotherapy for bipolar disorders. MATERIAL AND METHODS 1.Summary of the evidence for inpatient psychotherapy in adolescents and adults with bipolar disorders from current review articles and guidelines (German S3 guidelines, Australian, Canadian, and British NICE guidelines). 2. Systematic literature search (PRISMA) in Cochrane trials and Medline (via PubMed). 2a. Identification of original articles using the following search term: "bipolar fft" OR "bipolar ipsrt" OR "bipolar cbt" OR "bipolar cognitive remediation" OR "bipolar psychotherapy inpatient". 2b. Screening of n = 942 publications on the following inclusion criteria: randomized controlled efficacy trials, inpatient treatment/recruitment in the inpatient setting, adolescent or adult patients with bipolar disorder or caregivers. RESULTS The guidelines recommend a combination of pharmacotherapy and psychotherapy for the treatment of patients with bipolar disorders (so far no evidence-based presentation of inpatient psychotherapy). The results from reviews and original papers are heterogeneous. Recently described evidence-based psychotherapeutic approaches for inpatient treatment are family focused therapy (FFT), interpersonal and social rhythm therapy (IPSRT) and psychoeducation. CONCLUSION Although the current evidence is heterogeneous and further systematic studies are necessary, the results indicate that psychotherapy should be started or initiated in the inpatient setting with inclusion of caregivers.
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Katz D, Kuperberg M, Kamali M, George N, Mroczek D, Bastarache E, Stephan N, Nierenberg AA, Sylvia L. Decreased Psychological Well-Being in Patients With Bipolar Disorder in Remission. J Psychiatr Pract 2022; 28:445-453. [PMID: 36355583 DOI: 10.1097/pra.0000000000000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The goals of this study were to introduce psychological well-being as an important subject of inquiry in bipolar disorder, to compare well-being in a cohort of patients with bipolar disorder with that of a normative sample, and to assess whether common measures of well-being and mood measure empirically distinct phenomena. METHODS Participants were outpatients with bipolar I disorder in remission (N=37) from the Enhancing Emotion Regulation in Bipolar Disorder (EERBD) study and a matched community normative sample from the Midlife in the United States (MIDUS) survey (N=6297). The Psychological Well-Being Scale (PWBS) was used to measure psychological well-being. We calculated means and SD of scores on the PWBS and evaluated the differences between the scores of the bipolar I and community samples. We also tested the association between raw and change scores in depression [Hamilton Rating Scale for Depression (HAM-D)] and eudaimonic well-being (PWBS) using Spearman correlation coefficients. RESULTS The MIDUS survey sample (N=6297) was 48% male, with a mean age of 47 years (SD=13 y). The EERBD sample (N=37) was 27% male, with a mean age of 41 years (SD=11 y). In the bipolar sample, the baseline mean score on the HAM-D was 12.7 (SD=6.0) and the mean score on the Young Mania Rating Scale was 6.1 (SD=6.2). The baseline mean sum score on the PWBS in the normative community MIDUS sample was 100 (SD=14), while that of the bipolar I EERBD sample was 79 (SD=15) at baseline, 84 (SD=13) posttreatment, and 84 (SD=12) at the 3-month follow-up assessment. The effect sizes of the differences at all timepoints were large (Hedges g=1.42 at baseline, 1.11 at the end of treatment, and 1.06 at the 3-mo follow-up). No association was found between the PWBS and depression scores. CONCLUSIONS Outpatients with bipolar disorder in remission demonstrated substantially impaired psychological well-being, despite low levels of depressive symptoms, compared with a normative community sample.
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Yilmaz S, Huguet A, Kisely S, Rao S, Wang J, Baur K, Price M, O'Mahen H, Wright K. Do psychological interventions reduce symptoms of depression for patients with bipolar I or II disorder? A meta-analysis. J Affect Disord 2022; 301:193-204. [PMID: 35007645 DOI: 10.1016/j.jad.2021.12.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychological therapies may play an important role in the treatment of bipolar disorders. Several meta-analyses that examine the effectiveness of psychotherapies for patients with bipolar disorder include conclusions about the impact upon bipolar depression. However, these tend not to consider differences in depression outcome depending upon whether the therapy primarily targets acute depression, nor severity of baseline depression. This may affect the conclusions drawn about the effectiveness of these therapies for acute bipolar depression treatment. OBJECTIVES This meta-analysis explored the effectiveness of psychological therapies in reducing bipolar depression, in particular examining whether: (1) the effect of therapy is greater when baseline depressive symptoms are more severe, and (2) the effect of therapy is greater when the primary focus of the therapy is the treatment of acute bipolar depression? DATA SOURCES A systematic search was conducted using the following electronic databases; Cochrane Controlled Register of Trials (1996), MEDLINE (1966 onwards), EMBASE (1980 onwards), PsycINFO (1974 onwards), Scopus, Web of Science and Clinical Trials Registries (listed at:https://www.hhs.gov/ohrp/international/clinical-trial-registries/index.html). ELIGIBILITY CRITERIA Eligible studies were randomized controlled trials evaluating a psychological intervention for adults diagnosed with Bipolar I or II disorder. The comparators were usual care, wait-list, placebo, active treatment control. Post-treatment depression status was required to be measured continuously using a validated self- or observer- report measure, or categorically by a validated diagnostic instrument or clinical diagnosis by a suitably qualified person. DATA EXTRACTION AND SYNTHESIS Titles and abstracts were screened, followed by full texts. Two reviewers conducted each stage until agreement was reached, and both independently extracted study information. Means, standard deviations (SDs) and number of participants were retrieved from articles and used to perform a meta-analysis. The primary outcome was depressive symptom score. RESULTS The database search identified 6388 studies. After removing the duplicates, 3298 studies remained, of which, 28 studies were included in the qualitative review and 22 in the meta-analysis. Effect sizes range from -1.99 [-2.50, -1.49] to 0.89 [-0.12, 1.90]. There was low quality evidence of a significant effect on symptoms of depression for cognitive behavioral therapy and dialectical behavior therapy. Trials of psychoeducation, mindfulness-based therapy, family therapy and interpersonal and social rhythm therapy showed no evidence of any effect on depression. We found no significant relationship between baseline depression score and depression outcome post-treatment when we controlled for therapy type and comparator. The result also showed that the effect sizes for studies targeting acute depression to be tightly clustered around a small overall effect size. CONCLUSIONS Some psychological therapies may reduce acute bipolar depression although this conclusion should be viewed with caution given the low quality of evidence. More research using similar therapy types and comparators is needed to better understand the relationship between depression status at baseline and outcome.
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Affiliation(s)
- Sakir Yilmaz
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK.
| | - Anna Huguet
- Department of Community Health and Epidemiology, Dalhousie University, Canada; Departament de Psicologia, Universitat Rovira I Virgili, Spain; IWK Health Center, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, Dalhousie University, Canada; University of Queensland, Psychiatry, Australia; Metro South Addiction and Mental Health Epidemiology Service, Australia
| | - Sanjay Rao
- Faculty of Medicine, Psychiatry, University of Ottawa, Canada
| | - JianLi Wang
- Department of Psychiatry, University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, Canada
| | | | | | - Heather O'Mahen
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
| | - Kim Wright
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
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Kavitha RR, Kamalam S, Rajkumar RP. Effectiveness of Family-Focused Nurse-led Intervention on Functional Improvement of Patients with Bipolar Disorder at a Tertiary Hospital in South India: A Randomized Controlled Trial. Indian J Psychol Med 2022; 44:152-159. [PMID: 35655970 PMCID: PMC9120984 DOI: 10.1177/02537176211060557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Bipolar affective disorder (BPAD) is a chronic, episodic illness that can create problems and disruptions in the social, occupational, and family functioning of a client. Families are frequently most affected by their bipolar member and have a sense of helplessness to fix bipolar symptoms. The current study aimed to assess the effectiveness of Family-focused Nursing Interventions (FFNI) on functional improvement in the sample of symptomatic bipolar affective disorder clients. METHOD In this experimental study, 149 patients with BPAD were interviewed along with family members through the consecutive sampling technique from the inpatient ward. Varying block randomization was used to allocate the patients to the control and experimental groups. After obtaining ethical clearance, the study was registered under the Clinical trail registry India (CTRI). Baseline sociodemographic and clinical variables, and the functional levels, were assessed using Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool and Functional Assessment Short Test. The control group (74) received routine treatment; the experimental group (75) received routine treatment along with FFNI in seven sessions, and posttest was conducted at discharge, one-month, and at two-month follow-up at OPD. The collected data were analyzed using SPSS 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows Version 20.0, Armonk, NY: IBM Corp.), independent sample t-test, analysis of variance, and Pearson correlation used. A P-value of less than 0.05 was considered as a statistically significant result. RESULTS At the end of the study, 149 clients completed the treatment and follow-up. Both the groups were comparable at baseline in demography as well as clinical variables. There was significant improvement in the functional level after FFNI. The total score of LIFE-RIFT and the Functional Assessment Short Test score were significantly lower in the experimental group than the control group with P = 0.001. CONCLUSION The current study concluded that adjuvant to routine treatment FFNI will improve the functional ability of the client along with routine psychiatric treatment for BPAD.
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Affiliation(s)
- Rajendran Rangasamy Kavitha
- Dept. of Psychiatric Nursing, College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Ravi Philip Rajkumar
- Dept. of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
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Goulding EH, Dopke CA, Rossom RC, Michaels T, Martin CR, Ryan C, Jonathan G, McBride A, Babington P, Bernstein M, Bank A, Garborg CS, Dinh JM, Begale M, Kwasny MJ, Mohr DC. A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Empirical and Theoretical Framework, Intervention Design, and Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e30710. [PMID: 35188473 PMCID: PMC8902672 DOI: 10.2196/30710] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 12/18/2022] Open
Abstract
Background Bipolar disorder is a severe mental illness with high morbidity and mortality rates. Even with pharmacological treatment, frequent recurrence of episodes, long episode durations, and persistent interepisode symptoms are common and disruptive. Combining psychotherapy with pharmacotherapy improves outcomes; however, many individuals with bipolar disorder do not receive psychotherapy. Mental health technologies can increase access to self-management strategies derived from empirically supported bipolar disorder psychotherapies while also enhancing treatment by delivering real-time assessments, personalized feedback, and provider alerts. In addition, mental health technologies provide a platform for self-report, app use, and behavioral data collection to advance understanding of the longitudinal course of bipolar disorder, which can then be used to support ongoing improvement of treatment. Objective A description of the theoretical and empirically supported framework, design, and protocol for a randomized controlled trial (RCT) of LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder, is provided to facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar disorder. The goal of the trial is to determine the effectiveness of LiveWell for reducing relapse risk and symptom burden as well as improving quality of life (QOL) while simultaneously clarifying behavioral targets involved in staying well and better characterizing the course of bipolar disorder and treatment response. Methods The study is a single-blind RCT (n=205; 2:3 ratio of usual care vs usual care plus LiveWell). The primary outcome is the time to relapse. Secondary outcomes are percentage time symptomatic, symptom severity, and QOL. Longitudinal changes in target behaviors proposed to mediate the primary and secondary outcomes will also be determined, and their relationships with the outcomes will be assessed. A database of clinical status, symptom severity, real-time self-report, behavioral sensor, app use, and personalized content will be created to better predict treatment response and relapse risk. Results Recruitment and screening began in March 2017 and ended in April 2019. Follow-up ended in April 2020. The results of this study are expected to be published in 2022. Conclusions This study will examine whether LiveWell reduces relapse risk and symptom burden and improves QOL for individuals with bipolar disorder by increasing access to empirically supported self-management strategies. The role of selected target behaviors (medication adherence, sleep duration, routine, and management of signs and symptoms) in these outcomes will also be examined. Simultaneously, a database will be created to initiate the development of algorithms to personalize and improve treatment for bipolar disorder. In addition, we hope that this description of the theoretical and empirically supported framework, intervention design, and study protocol for the RCT of LiveWell will facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar and other mental health disorders. Trial Registration ClinicalTrials.gov NCT03088462; https://www.clinicaltrials.gov/ct2/show/NCT03088462 International Registered Report Identifier (IRRID) DERR1-10.2196/30710
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Affiliation(s)
- Evan H Goulding
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia A Dopke
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Tania Michaels
- Department of Psychiatry, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Clair R Martin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Chloe Ryan
- Carolina Outreach, Durham, NC, United States
| | - Geneva Jonathan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alyssa McBride
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Pamela Babington
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Mary Bernstein
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Andrew Bank
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - C Spencer Garborg
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | | | - Mary J Kwasny
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David C Mohr
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Wittenborn AK, Woods SB, Priest JB, Morgan PC, Tseng CF, Huerta P, Edwards C. Couple and family interventions for depressive and bipolar disorders: Evidence base update (2010-2019). JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:129-153. [PMID: 34750834 DOI: 10.1111/jmft.12569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
This article systematically reviews the evidence base for couple and family interventions for depressive and bipolar disorders published from 2010 to 2019. Included in the review were intervention studies on depression for couples (n = 6), depression for families (n = 13), and bipolar for families (n = 5); zero studies on couple interventions for bipolar were located. Well-established interventions include cognitive and/or behavioral couple and family interventions for depression and psychoeducational family interventions for bipolar. Attachment-based couple and family interventions for depression are probably efficacious. Finally, family psychoeducation for depression is possibly efficacious, and integrative couple interventions and family play-based interventions for depression are experimental. Couple and family interventions also improved relationship dynamics, which is noteworthy since poor relationships are associated with non-remission, relapse, and recurrence of depressive and bipolar symptoms. Future research is needed on couple interventions for bipolar disorders and interventions for minoritized populations.
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Affiliation(s)
- Andrea K Wittenborn
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
- Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Sarah B Woods
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jacob B Priest
- Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa, USA
| | - Preston C Morgan
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Chi-Fang Tseng
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Patricia Huerta
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Caitlin Edwards
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
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Rabelo JL, Cruz BF, Ferreira JDR, Viana BDM, Barbosa IG. Psychoeducation in bipolar disorder: A systematic review. World J Psychiatry 2021; 11:1407-1424. [PMID: 35070785 PMCID: PMC8717031 DOI: 10.5498/wjp.v11.i12.1407] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/11/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a severe psychiatric disorder characterized by mood swings. Psychosocial interventions, such as psychoeducation, play an essential role in promoting social rehabilitation and improving pharmacological treatment.
AIM To investigate the role of psychoeducation in BD.
METHODS A systematic review of original studies regarding psychoeducation interventions in patients with BD and their relatives was developed. A systematic literature search was performed using the Medline, Scopus, and Lilacs databases. No review articles or qualitative studies were included in the analysis. There were no date restriction criteria, and studies published up to April 2021 were included.
RESULTS A total of forty-seven studies were selected for this review. Thirty-eight studies included patients, and nine included family members. Psychoeducation of patients and family members was associated with a lower number of new mood episodes and a reduction in number and length of stay of hospitalizations. Psychoeducational interventions with patients are associated with improved adherence to drug treatment. The strategies studied in patients and family members do not interfere with the severity of symptoms of mania or depression or with the patient's quality of life or functionality. Psychoeducational interventions with family members do not alter patients' adherence to pharmacotherapy.
CONCLUSION Psychoeducation as an adjunct strategy to pharmacotherapy in the treatment of BD leads to a reduction in the frequency of new mood episodes, length of hospital stay and adherence to drug therapy.
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Affiliation(s)
- Juliana Lemos Rabelo
- Interdisciplinary Laboratory of Medical Investigation–School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Breno Fiuza Cruz
- Interdisciplinary Laboratory of Medical Investigation–School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Department of Mental Health, School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | | | - Bernardo de Mattos Viana
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Department of Mental Health, School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Izabela Guimarães Barbosa
- Interdisciplinary Laboratory of Medical Investigation–School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Department of Mental Health, School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
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Johansen KK, Hounsgaard L, Hansen JP, Fluttert FAJ. Early Recognition Method - Amplifying relapse management in community mental health care; a comprehensive study of the effects on relapse and readmission. Arch Psychiatr Nurs 2021; 35:587-594. [PMID: 34861950 DOI: 10.1016/j.apnu.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/18/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
This naturalistic multicenter study explored the relationship between participating in the Early Recognition Method (ERM) intervention and relapse, defined as spending at least one night at a psychiatric ward. The intervention was tailored to adult patients with schizophrenia or bipolar disorder in an outpatient mental health care setting. Before the intervention, the staff received training in application of the strategy. The ERM strategy is protocolized and includes identification and monitoring of individual early warning signs and development of a personal plan of action. The study showed a reduction in mean number and duration of readmissions during the period the patients participated in the intervention, compared to an equal pre-intervention period. For patients with bipolar disorder the reduction was statistical significant. The difference in outcome between the two diagnostic groups suggests that further tailoring of the application of the ERM strategy might improve the relapse prevention outcome.
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Affiliation(s)
- Kirsten Kjær Johansen
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark; Mental Health Department Esbjerg, University Clinic, Region of Southern Denmark, Denmark; OPEN - Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Denmark; Center for Psychiatric Nursing and Health Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark.
| | - Lise Hounsgaard
- OPEN - Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Denmark; Center for Psychiatric Nursing and Health Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Nursing & Health Science Nuuk, University of Greenland, Greenland
| | - Jens Peter Hansen
- Mental Health Department Esbjerg, University Clinic, Region of Southern Denmark, Denmark; Center for Psychiatric Nursing and Health Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Frans A J Fluttert
- Center for Psychiatric Nursing and Health Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; FPC Dr. S. van Mesdag, Netherlands; Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Norway; Faculty of Health and Social Sciences Molde University College, Norway
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Johansen KK, Hounsgaard L, Frandsen TF, Fluttert FAJ, Hansen JP. Relapse prevention in ambulant mental health care tailored to patients with schizophrenia or bipolar disorder. J Psychiatr Ment Health Nurs 2021; 28:549-577. [PMID: 33259667 DOI: 10.1111/jpm.12716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/06/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS ALREADY KNOWN ON THE SUBJECT?: Understanding the need for psychoeducation and management strategies in relapse prevention, for individuals with schizophrenia or bipolar disorder. Interventions for individuals with severe mental illness, especially schizophrenia, often requires support from family or social network to successfully improve mental stability in the life of the mentally ill. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To our knowledge, no previous review has provided an overview of state of the art intervention elements currently used in ambulant mental health care interventions and how these elements are combined in interventions tailored to individuals with schizophrenia or bipolar disorder. Moreover, this systematic review indicates the effect of the different intervention elements. This review reveals an apparent gab in knowledge regarding patient perceptions of and need for individualized relapse prevention interventions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The review is a relevant tool for stakeholders and practitioners in community mental health service when planning future interventions. Considering the specific needs for intervention complexity of the target group is likely to improve not only treatment outcome, but also patient satisfaction and treatment adherence. ABSTRACT: Introduction In recent years, there has been a development in ambulant mental health care towards a more preventive approach, resulting in relapse prevention interventions. Interventions may be patient tailored, to a greater or lesser extent, in relation to the treatment elements included. Aim To create an overview of non-pharmacological intervention elements described in relapse prevention interventions for patients with schizophrenia or bipolar disorder based on a systematic review. Method Six scientific databases were systematically searched. The search strategy, identification and selection of literature complied with the PRISMA statement. Results Of 7.429 studies screened, 25 were included for analysis. Six treatment elements were identified: Pharmacological treatment, personalized action plan, patient education, patient skills, treatment adherence and family involvement. Discussion The varying degree of complexity of the interventions indicates that patients with bipolar disorder and schizophrenia have, respectively, different treatment needs. Patients with schizophrenia seem to benefit more from interventions that include support from social network or family than patients with bipolar disorder. More qualitative studies clarifying the patient's perspective on tailored relapse prevention are indicated. Implications for practice Optimally tailoring relapse prevention for patients with schizophrenia and bipolar disorder will improve treatment outcome, and probably also treatment satisfaction and adherence.
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Affiliation(s)
- Kirsten Kjaer Johansen
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,Mental Health Department Esbjerg, University Clinic, Region of Southern Denmark, Esbjerg N, Denmark.,OPEN - Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Psychiatric Nursing and Health Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lise Hounsgaard
- OPEN - Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Psychiatric Nursing and Health Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Center; Department of Nursing & Health Science, Nuuk, University of Greenland, Nuuk, Greenland
| | - Tove Faber Frandsen
- Department of Design and Communication, University of Southern Denmark, Kolding, Denmark
| | - Frans A J Fluttert
- Center for Psychiatric Nursing and Health Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,FPC Dr. S. van Mesdag Netherlands, Groningen, Denmark.,Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Oslo, Norway.,Faculty of Health and Social Sciences, Molde University College, Molde, Norway
| | - Jens Peter Hansen
- Mental Health Department Esbjerg, University Clinic, Region of Southern Denmark, Esbjerg N, Denmark.,Center for Psychiatric Nursing and Health Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Padmavathi N, Gandhi S, Manjula M, Viswanath B, Jain S. Family Focused Therapy for Family Members of Patients with Bipolar Disorder: Case Reports of Its Impact on Expressed Emotions. Indian J Psychol Med 2021; 43:261-264. [PMID: 34345104 PMCID: PMC8287388 DOI: 10.1177/0253717620950253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Caregivers of patients with bipolar disorder (BD) undergo a considerable amount of burden. In India, family caregivers are the primary source of support and care for their ill relatives. The burden faced by family members of patients with BD often results in physical and mental health consequences. This may lead to negative interaction patterns such as hostility, criticality, and overinvolvement, termed as expressed emotions (EE). Here, we report how we addressed the EE in family members, using a single-subject design that involved the family caregivers (n = 2) of two adults who presented with a diagnosis of BD with a current episode of mania. An assessment of family caregivers, using the family questionnaire, revealed high EE. Family focused therapy (FFT) of 12 sessions was delivered over 3-4 weeks on an inpatient basis, with positive outcomes of reductions in EE and family stress and improved psychosocial functioning in patient that were sustained over 9-10 months. FFT can be an important add on psychosocial therapy to reduce EE and stress and to facilitate functioning and communication.
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Affiliation(s)
- N Padmavathi
- Dept. of Nursing, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sailaxmi Gandhi
- Dept. of Nursing, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Manjula M
- Dept. of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
| | - Biju Viswanath
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Sanjeev Jain
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Valls È, Bonnín CM, Torres I, Brat M, Prime-Tous M, Morilla I, Segú X, Solé B, Torrent C, Vieta E, Martínez-Arán A, Reinares M, Sánchez-Moreno J. Efficacy of an integrative approach for bipolar disorder: preliminary results from a randomized controlled trial. Psychol Med 2021; 52:1-12. [PMID: 33858527 PMCID: PMC9811269 DOI: 10.1017/s0033291721001057] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Bipolar disorder (BD) represents one of the most therapeutically complex psychiatric disorders. The development of a feasible comprehensive psychological approach to complement pharmacotherapy to improve its clinical management is required. The main objective of the present randomized controlled trial (RCT) was to test the efficacy of a novel adjunctive treatment entitled integrative approach in patients with BD, including: psychoeducation, mindfulness training, and functional remediation. METHODS This is a parallel two-armed, rater-blind RCT of an integrative approach plus treatment as usual (TAU), v. TAU alone. Participants were recruited at the Hospital Clinic of Barcelona and randomized to one of the two conditions. They were assessed at baseline and after finishing the intervention. The main outcome variable included changes in psychosocial functioning assessed through the Functioning Assessment Short Test (FAST). RESULTS After finishing the treatment, the repeated-measures analyses revealed a significant group × time interaction in favor of the patients who received the integrative approach (n = 28) compared to the TAU group (n = 37) (Pillai's trace = 0.10; F(1,57) = 6.9; p = 0.01), improving the functional outcome. Significant effects were also found in two out of the six domains of the FAST, including the cognitive domain (Pillai's trace = 0.25; F(1,57) = 19.1; p < 0.001) and leisure time (Pillai's trace = 0.11; F(1,57) = 7.15; p = 0.01). Regarding the secondary outcomes, a significant group × time interaction in Hamilton Depression Rating Scale changes was detected (Pillai's trace = 0.08; F(1,62) = 5.6; p = 0.02). CONCLUSION This preliminary study suggests that the integrative approach represents a promising cost-effective therapy to improve psychosocial functioning and residual depressive symptoms in patients suffering from BD.
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Affiliation(s)
- Èlia Valls
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - C. Mar Bonnín
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Imma Torres
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Mercè Brat
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Mireia Prime-Tous
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Ivette Morilla
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Xavier Segú
- Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Brisa Solé
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Carla Torrent
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - María Reinares
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
| | - José Sánchez-Moreno
- Barcelona Bipolar Disorders and Depressive Unit, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Hospital Clínic of Barcelona, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
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Espinós U, Fernández-Abascal EG, Ovejero M, Lahera G. Social cognition in first-degree relatives of bipolar disorder: Theory of Mind and nonverbal sensitivity. PLoS One 2021; 16:e0246908. [PMID: 33651831 PMCID: PMC7924770 DOI: 10.1371/journal.pone.0246908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Abstract
Social cognition might be impaired in first degree relatives (FDR) of BD but existing research shows controversial results about social cognitive impairments in this population. The aim of this study was to assess Theory of Mind (ToM) and nonverbal sensitivity in FDR of BD and compare the results with those of two groups of persons with remitted bipolar disorder (BD), type I and II, and a control group. Social cognitive ability was examined in first degree relatives of BD, with a biological parent, offspring or sibling diagnosed with the disorder. For this study, 37 FDRs of bipolar patients, 37 BD I, 40 BD II and 40 control participants were recruited. Social cognition was explored by means of the Reading the Mind in the Eyes Test and the MiniPONS. Results showed a significant impairment in FDR of BD in the ToM task, but not in nonverbal sensitivity. Performance of FDRs in social cognition is better than that of BDs (either type I or type II) but worse when compared with that of healthy individuals without a family history of psychiatric disorders. Nevertheless, no differences were found between BD I and BD II groups. Males and older participants showed a worse performance in all groups. Group family therapy with FDRs of BD might include training in the recognition of nonverbal cues, which might increase the understanding of their familiars with BD, in order to modify communication abilities.
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Affiliation(s)
- Usue Espinós
- Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, Spain
- * E-mail:
| | | | - Mercedes Ovejero
- Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
| | - Guillermo Lahera
- Facultad de Medicina, Universidad de Alcalá de Henares, Madrid, Spain
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Relapse and Clinical Characteristics of Patients with Bipolar Disorders in Central Ethiopia: A Cross-Sectional Study. PSYCHIATRY JOURNAL 2020; 2020:8986014. [PMID: 33062661 PMCID: PMC7539106 DOI: 10.1155/2020/8986014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/03/2020] [Accepted: 09/09/2020] [Indexed: 12/04/2022]
Abstract
Background Bipolar disorder is a severe mental illness and has huge morbidity and mortality. Relapse is a challenging treatment failure in patients with mental illness, especially in patients with bipolar which causes high economic and social burdens. In the mental health delivery system, relapse is common and can be defined as becoming ill again after apparent recovery and a worsening condition of psychiatric patients. Due to psychiatric patients that may stop medication on their own in contrary to the advice of mental health professionals, relapse of mood episodes, delayed remission, and residual symptoms usually leads to hospitalization, increased suicide risk, and/or impede psychosocial recover. Therefore, understanding the nature of relapse in patients in low-income countries helps to prevent recurrence and related health care expenses. Objective The objective of this study was to assess the prevalence and factors associated with relapse among patients with bipolar disorders in central Ethiopia. Method Facility-based cross-sectional study was conducted from May to June 2015 at Amanuel Mental Specialized Hospital. Relapse was calculated among 400 samples of people with bipolar disorder, and systematic random sampling was used to select the study participants. Oslo's social support scale and ASSIST were used to identify factors with relapse, and a binary and multivariable logistic regression analysis model was performed to control the confounding factors. Odds ratios (OR) with the corresponding 95% confidence interval (95% CI) were determined to evaluate the strength of association. Results The prevalence of relapse was 71% among patients with bipolar disorder. The longer morbidity (longer than 5 years) had a higher risk of relapse [adjusted odd ratio (AOR) = 3.91, 95% confidence interval (CI): 2.44 to 6.27], while good medication adherence found to be a protective factor for relapse [AOR = 0.39, 95% CI: 0.22 to 0.72]. Conclusion The prevalence of relapse was found pretty high among patients with bipolar disorders (71%). Working on treatment adherence and controlling the psychopathology is important to prevent relapse among bipolar patients.
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Feasibility of a Brief Online Psychoeducational Intervention for Women With Sexual Interest/Arousal Disorder. J Sex Med 2020; 17:2208-2219. [PMID: 32919927 PMCID: PMC7480645 DOI: 10.1016/j.jsxm.2020.07.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/14/2020] [Accepted: 07/31/2020] [Indexed: 01/07/2023]
Abstract
Background Low sexual desire and arousal are the most common sexual concerns in women, but most women lack access to effective treatment such as cognitive behavioral therapy. Web-based psychological interventions, which are economical, private, easily accessible, and potentially effective, may increase the reach of evidence-based treatment. Aim To determine the feasibility of translating cognitive behavioral therapy for the most common female sexual dysfunction, Female Sexual Interest/Arousal Disorder, into an online format. The present study examined the feasibility of an introductory psychoeducational module of eSense, an online program currently being developed that is based on existing empirically supported in-person treatments, which delivers content to the user in a visually appealing and interactive manner. Methods Sixteen cisgender women (M age = 31.9) with female sexual arousal/interest disorder worked through a pilot module of eSense inperson at a sexual health laboratory. Outcomes Qualitative semistructured interviews and online questionnaires were used to assess participants’ experiences of usability of the platform, clarity/relevance of the content, satisfaction with the experience, and any changes in clinical outcomes of sexual function and distress. Results Participants reported a high level of satisfaction with the website’s functionality and presentation. They reported greater knowledge, felt validated and more hopeful, and were eager to continue the remaining modules. Participants also reported notable prepost improvements in sexual desire, arousal, and satisfaction. Clinical Implications Initial user-experience assessment may represent a method of simultaneously improving online interventions and providing therapeutic education to participants. Strengths & Limitations This is one of the first studies, to our knowledge, to test a graphics-rich, interactive online intervention for sexual difficulties that does not require direct contact with expert providers or support groups. Limitations include the high level of education, motivation, and technical fluency of the sample and the potentially confounding effect of the researcher’s presence during interviews. Because this was a feasibility study, the sample size was small, and no control group was included, limiting conclusions about efficacy and generalizability. Conclusion The format of eSense appears to be feasible and usable, lending support to the growing evidence that it is possible to take in-person therapeutic interventions online. Zippan N, Stephenson KR, Brotto LA, Feasibility of a Brief Online Psychoeducational Intervention for Women With Sexual Interest/Arousal Disorder. J Sex Med 2020;17:2208–2219.
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Berardelli I, Erbuto D, Rogante E, Sarubbi S, Lester D, Pompili M. Making Sense of the Unique Pain of Survivors: A Psychoeducational Approach for Suicide Bereavement. Front Psychol 2020; 11:1244. [PMID: 32714228 PMCID: PMC7344316 DOI: 10.3389/fpsyg.2020.01244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/12/2020] [Indexed: 11/13/2022] Open
Abstract
Grief, guilt, abandonment, anger, shame, and rejection are the most common feelings experienced by suicide survivors, who differ from other bereaved individuals for the intensity of these feelings. Moreover, suicide risk and psychiatric disorders associated with suicidality are more frequent in people who have lost a loved person by suicide. Given the complexity and the consequences linked to the suicide of a loved person, it is necessary to act promptly. Among the various strategies, psychoeducation has proved effective for several mental disorders and for suicide bereavement. It is a therapeutic intervention aimed at identifying and understanding the psychological features associated with the mental pain of suicide survivors, to facilitate the management of the illness and the recognition of relationships in the social environment. We developed a psychoeducational group that took place at the Suicide Prevention Center of the Sant'Andrea Hospital in Rome. It was a homogeneous, finite-group composed of 8-12 suicide survivors and conducted by two trained psychologists supervised weekly by the Director of the Suicide Prevention Center. The intervention comprised 21 weekly sessions of 90 min. Each session concerned a determined topic and began with the presentation of the issue, continued with specific exercises, and finished with a group discussion. The main goals of the group were to provide support, normalize the reactions of the survivors, and assist them in reducing their emotional suffering and their thoughts about suicide, investigate the potential presence of suicide risk, implement prevention strategies, and integrate the loss of the loved person. The psychoeducational approach we delivered for suicide survivors allows individuals to interact with other individuals in the same situation in order to help them resume the normal course of life, placing the suicide of a loved person in a broader perspective.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Rogante
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sarubbi
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - David Lester
- Department of Psychology, Stockton University, Galloway, NJ, United States
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Novick DM, Swartz HA. Evidence-Based Psychotherapies for Bipolar Disorder. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2019; 17:238-248. [PMID: 32047369 DOI: 10.1176/appi.focus.20190004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bipolar disorder is a recurrent psychiatric disorder marked by waxing and waning affective symptoms and impairment in functioning. Some of the morbidity and mortality associated with the illness may be reduced with evidence-based psychotherapies (EBPs) along with pharmacotherapy. To enhance clinicians' understanding of which therapy modalities have evidence supporting their use, the authors conducted a systematic literature review to identify randomized controlled trials (RCTs) of psychotherapy for adults with bipolar disorder. A strong evidence base exists for psychoeducation, cognitive-behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and peer-support programs. Promising modalities include functional remediation, mindfulness-based cognitive therapy, illness management and recovery, and technology-assisted strategies. RCTs demonstrate a consistent advantage of these psychotherapies plus pharmacotherapy, compared with the use of pharmacotherapy alone. Adjunctive EBPs hasten time to remission, delay time to recurrence, and improve functional outcomes. EBPs play an important role in helping individuals develop skills needed to manage the persistent and lifelong psychosocial, neurocognitive, vocational, and interpersonal consequences of bipolar disorder. Continued efforts to improve the effectiveness of EBPs for adults with bipolar disorder are warranted.
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Affiliation(s)
- Danielle M Novick
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
| | - Holly A Swartz
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
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L’éducation thérapeutique : un levier pour modifier les perceptions du trouble bipolaire chez les aidants familiaux. Encephale 2019; 45:239-244. [DOI: 10.1016/j.encep.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/29/2018] [Accepted: 11/11/2018] [Indexed: 12/20/2022]
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Soleimannejad M, Zamir M, Javani M. Impact of family psychoeducation on hospitalization and relapse of bipolar disorder in patients with mixed and manic episodes:A randomized controlled clinical trial. SOCIAL HEALTH AND BEHAVIOR 2019. [DOI: 10.4103/shb.shb_5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Miguel SRPS, Lima AFBS, Cruz LN, Cohen M, Zimmermann JJ, Ziegelmann PK, Fleck MPA. Bipolar Disorder Mixed Episodes: A Pragmatic Trial of a Public Health Treatment Effectiveness. Value Health Reg Issues 2018; 17:158-163. [PMID: 30316147 DOI: 10.1016/j.vhri.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of an algorithm for the treatment of mixed episodes in bipolar disorder (BD) using the medications available under the Unified Health System (Sistema Único de Saúde) in Brazil. METHODS The study included 107 individuals with BD in a current mixed episode, assessed biweekly for the outcomes of response and remission. The subjects were randomly assigned to start treatment with lithium, valproic acid, or carbamazepine, following a clinical protocol at a public outpatient clinic. Eligibility screening instruments, semistructured interview, and clinical psychiatric evaluation were used for diagnosis. To measure response and remission, the Hamilton Rating Scale for Depression and the Young Mania Rating Scale were used. A parameter of 50% or less in the symptom scales was used to define responses, as assessed by Kaplan-Meier time-event analysis. RESULTS For the main outcome, response to treatment, all interventions proposed were proven to be effective, with no difference in response time for any of them. There was a lack of placebo control and blinding for intervention or outcomes. Individuals with mixed episodes in BD often face contradictory symptoms, and these inherent difficulties are the main obstacles to stabilize such a condition. CONCLUSIONS The findings presented in this study show that the treatments available under the Unified Health System are able to reduce the overall burden of disease in terms of symptom reduction.
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Affiliation(s)
- Sandro René P S Miguel
- Institute for Health Technology Assessment, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ana Flávia B S Lima
- Institute for Health Technology Assessment, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciane N Cruz
- Institute for Health Technology Assessment, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mírian Cohen
- Institute for Health Technology Assessment, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jacques J Zimmermann
- Institute for Health Technology Assessment, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Patrícia K Ziegelmann
- Institute for Health Technology Assessment, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Department of Statistics, Instituto de Matemática, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Graduates Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcelo P A Fleck
- Graduates Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Simhandl C, König B. [Impact of psychoeducation on the disease concept in bipolar patients]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2018; 32:159-167. [PMID: 29675657 DOI: 10.1007/s40211-018-0268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
Aim of the investigation was the proof of influence of specific psychoeducation for bipolar disorder patients and their concept of illness. Additionally we looked in a subsample at the in literature described equal efficacy of peer to peer councelling and councelling by bipolar specialists in psychoeducationIn our investigation on 176 bipolar patients we could show in group psychoeducation that specific group psychoeducation by trained personal and by experts leads to a changed perception of the disorder concept. The participants relied more in medication and trusted doctors and agreed to suffer from a serious disorder. Our results show that the additional factor alcohol consumption abolishes the effect of psychoeducation in bipolar patients.The concept of the disease was only changed in patients without alcohol consumption. This group showed additional decrease of negetive expectancies and had a hopeful attitude regarding the further course of the disorder.In a subgroup where experts (peers) were trained for psychoeducation councelling and performed peer to peer psychoeducational groups we found the same positive changes in the attitude towards the disorder, but there was a significant higher proportion of dropouts in the peer leaded groups.
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Affiliation(s)
- Christian Simhandl
- Sigmund Freud Privatuniversität Wien, Freudplatz 1, 1020, Wien, Österreich.
- Bipolar Zentrum Wiener Neustadt, Bahngasse 43, 2700, Wiener Neustadt, Österreich.
| | - Barbara König
- Bipolar Zentrum Wiener Neustadt, Bahngasse 43, 2700, Wiener Neustadt, Österreich
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Lee HJ, Lin ECL, Chen MB, Su TP, Chiang LC. Randomized, controlled trial of a brief family-centred care programme for hospitalized patients with bipolar disorder and their family caregivers. Int J Ment Health Nurs 2018; 27:61-71. [PMID: 28000377 DOI: 10.1111/inm.12294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2016] [Indexed: 11/28/2022]
Abstract
Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients' symptoms and health; however, the effects of family interventions on family function and caregivers' health-related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family-centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60-min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90-min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P = 0.03) and subscale conflict (P = 0.04), communication (P = 0.01), and problem-solving (P = 0.04), but there were no significant interaction effects on the caregivers' perceived health status and caregivers' burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers.
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Affiliation(s)
- Hsiu-Ju Lee
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Esther Ching-Lan Lin
- Department of Nursing, National Cheng Kung University and Hospital, Tainan, Taiwan
| | - Mei-Bih Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tung-Ping Su
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Chi Chiang
- School of Nursing, National Defense Medical Center and China Medical University, Taipei and Taichung, Taiwan
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Morriss R. The early warning symptom intervention for patients with bipolar affective disorder. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.10.1.18] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Randomised controlled trials and surveys of patients' experiences indicate that the recognition and prompt treatment of early warning signs of relapse in selected patients with bipolar affective disorder are effective in lengthening the time to the next manic relapse and improving function. Improvements in patient coping mechanisms allied to these techniques can prevent some depressive episodes. The intervention is described in some detail and conditions under which it is most likely to be effective or to fail are reviewed. If the intervention is to be successful, patients must be carefully selected, early warning signs and symptoms must be analysed in detail, it must be a central feature of the care plan and the service must be ready to respond quickly to a patient's early warning symptoms.
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Abstract
SummaryBipolar disorder is a complex disorder of mood and behaviour that requires a multimodal treatment approach. In the past 10 years there has been growing interest in psychoeducational interventions delivered as adjuncts to conventional management. Several studies have tested the effectiveness of psychoeducational treatments delivered in a variety of formats. In this article we assess the evidence for the efficacy of these interventions and consider the likely future role of structured psychoeducational treatments in clinical practice.
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Abstract
Drawing on clinical data from 15 months of on-site participant observation in the only public psychiatric hospital in the state of Puebla, Mexico, this article advances our understanding of globalization in relation to psychiatry. I challenge the construction of psychiatry as only treating the individual patient and provide grounded doctor-patient-family member interaction in a Mexican psychiatric clinic in order to review what happens when doctors cannot interact with patients as atomized individuals even though in theory they are trained to think of patients that way. Challenged by severe structural constraints and bolstered by lessons from other nations' efforts at deinstitutionalization, psychiatrists in Puebla push to keep patients out of the inpatient wards and in their respective communities. To this end, psychiatrists call upon co-present kin who are identified both as the customer and part of the caretaking system outside the clinic. This modification to the visit structure changes the dynamic and content of clinical visits while doctors seamlessly respond to unspoken beliefs and values that are central to local life, ultimately showing that efforts to define a "global psychiatry" informed by global policy will fail because it cannot exist in a uniform way-interpersonal interaction and personal experience matters.
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Chakrabarti S. Medication non-adherence in bipolar disorder: Review of rates, demographic and clinical predictors. World J Meta-Anal 2017; 5:103-123. [DOI: 10.13105/wjma.v5.i4.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/24/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To conduct a systematic search for all studies examining rates and demographic and illness-related determinants of medication non-adherence in bipolar disorder (BD).
METHODS A comprehensive literature search was undertaken of six English-language databases to identify published articles on medication non-adherence in BD from inception till December 2016. Any article, either a review or an original-research article was examined for its relevance to the subject. All such articles were manually searched to locate any further articles containing relevant information. Studies were included only if they had adequately described the patient sample, assessment methods and statistical procedures, presented their results systematically and their conclusions were congruent with the results.
RESULTS The initial search yielded 249 articles on the subject; of these 198 articles were included. Of the 162 original-research studies, 132 had provided information on rates of medication non-adherence in BD. There was a wide variation in rates ranging from universal adherence (100%) to almost universal non-adherence (96%); this discrepancy was more due to methodological differences than true variations in rates. Notwithstanding the significant discrepancies in methodology, based on these 132 studies mean rates of 41.5%-43% and median rates of 40%-41% were obtained for medication non-adherence in BD. Rates of adherence with mood stabilizers were significantly lower than those for antipsychotics, or for medications of all classes. None of the demographic attributes were unequivocally linked to medication non-adherence in BD. Similarly, medication-related variables such as type of medications, doses, treatment regimens and side effects did not demonstrate consistent associations with non-adherence. Among clinical characteristics the presence of comorbid substance use disorder and absence of insight were the only two factors clearly linked to non-adherence in BD.
CONCLUSION Medication non-adherence is prevalent in about a third to half of patients with BD. Demographic, illness and treatment related factors do not predict non-adherence with certainty.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Hollon SD, Thase ME, Markowitz JC. Treatment and Prevention of Depression. Psychol Sci Public Interest 2017; 3:39-77. [DOI: 10.1111/1529-1006.00008] [Citation(s) in RCA: 292] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression is one of the most common and debilitating psychiatric disorders and is a leading cause of suicide. Most people who become depressed will have multiple episodes, and some depressions are chronic. Persons with bipolar disorder will also have manic or hypomanic episodes. Given the recurrent nature of the disorder, it is important not just to treat the acute episode, but also to protect against its return and the onset of subsequent episodes. Several types of interventions have been shown to be efficacious in treating depression. The antidepressant medications are relatively safe and work for many patients, but there is no evidence that they reduce risk of recurrence once their use is terminated. The different medication classes are roughly comparable in efficacy, although some are easier to tolerate than are others. About half of all patients will respond to a given medication, and many of those who do not will respond to some other agent or to a combination of medications. Electro-convulsive therapy is particularly effective for the most severe and resistant depressions, but raises concerns about possible deleterious effects on memory and cognition. It is rarely used until a number of different medications have been tried. Although it is still unclear whether traditional psychodynamic approaches are effective in treating depression, interpersonal psychotherapy (IPT) has fared well in controlled comparisons with medications and other types of psychotherapies. It also appears to have a delayed effect that improves the quality of social relationships and interpersonal skills. It has been shown to reduce acute distress and to prevent relapse and recurrence so long as it is continued or maintained. Treatment combining IPT with medication retains the quick results of pharmacotherapy and the greater interpersonal breadth of IPT, as well as boosting response in patients who are otherwise more difficult to treat. The main problem is that IPT has only recently entered clinical practice and is not widely available to those in need. Cognitive behavior therapy (CBT) also appears to be efficacious in treating depression, and recent studies suggest that it can work for even severe depressions in the hands of experienced therapists. Not only can CBT relieve acute distress, but it also appears to reduce risk for the return of symptoms as long as it is continued or maintained. Moreover, it appears to have an enduring effect that reduces risk for relapse or recurrence long after treatment is over. Combined treatment with medication and CBT appears to be as efficacious as treatment with medication alone and to retain the enduring effects of CBT. There also are indications that the same strategies used to reduce risk in psychiatric patients following successful treatment can be used to prevent the initial onset of depression in persons at risk. More purely behavioral interventions have been studied less than the cognitive therapies, but have performed well in recent trials and exhibit many of the benefits of cognitive therapy. Mood stabilizers like lithium or the anticonvulsants form the core treatment for bipolar disorder, but there is a growing recognition that the outcomes produced by modern pharmacology are not sufficient. Both IPT and CBT show promise as adjuncts to medication with such patients. The same is true for family-focused therapy, which is designed to reduce interpersonal conflict in the family. Clearly, more needs to be done with respect to treatment of the bipolar disorders. Good medical management of depression can be hard to find, and the empirically supported psychotherapies are still not widely practiced. As a consequence, many patients do not have access to adequate treatment. Moreover, not everyone responds to the existing interventions, and not enough is known about what to do for people who are not helped by treatment. Although great strides have been made over the past few decades, much remains to be done with respect to the treatment of depression and the bipolar disorders.
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Affiliation(s)
| | - Michael E. Thase
- University of Pittsburgh Medical Center and Western Psychiatric Institute and Clinic
| | - John C. Markowitz
- Weill Medical College of Cornell University and New York State Psychiatric Institute
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Chatterton ML, Stockings E, Berk M, Barendregt JJ, Carter R, Mihalopoulos C. Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: network meta-analysis. Br J Psychiatry 2017; 210:333-341. [PMID: 28209591 DOI: 10.1192/bjp.bp.116.195321] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/30/2016] [Accepted: 11/06/2016] [Indexed: 12/17/2022]
Abstract
BackgroundFew trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional meta-analyses provided limited comparisons between therapies.AimsTo combine evidence for the efficacy of psychosocial interventions used as adjunctive treatment of bipolar disorder in adults, using network meta-analysis (NMA).MethodSystematic review identified studies and NMA was used to pool data on relapse to mania or depression, medication adherence, and symptom scales for mania, depression and Global Assessment of Functioning (GAF).ResultsCarer-focused interventions significantly reduced the risk of depressive or manic relapse. Psychoeducation alone and in combination with cognitive-behavioural therapy (CBT) significantly reduced medication non-adherence. Psychoeducation plus CBT significantly reduced manic symptoms and increased GAF. No intervention was associated with a significant reduction in depression symptom scale scores.ConclusionsOnly interventions for family members affected relapse rates. Psychoeducation plus CBT reduced medication non-adherence, improved mania symptoms and GAF. Novel methods for addressing depressive symptoms are required.
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Affiliation(s)
- Mary Lou Chatterton
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Emily Stockings
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Jan J Barendregt
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Rob Carter
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Cathrine Mihalopoulos
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
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Simoneau TL, Kilbourn K, Spradley J, Laudenslager ML. An evidence-based stress management intervention for allogeneic hematopoietic stem cell transplant caregivers: development, feasibility and acceptability. Support Care Cancer 2017; 25:2515-2523. [PMID: 28283805 DOI: 10.1007/s00520-017-3660-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/06/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE Caregivers of cancer patients face challenges impacting their physical, psychological and social well-being that need attention in the form of well-designed and tested interventions. We created an eight-session individual stress management intervention for caregivers of allogeneic hematopoietic stem cell transplant (Allo-HSCT) recipients. This intervention, tested by randomized control trial, proved effective in decreasing distress. Herein, we describe the intervention including theoretical framework, development, and elements of fidelity. Implementation challenges along with recommendations for refinement in future studies are discussed with the goal of replication and dissemination. METHODS Seventy-four of 148 caregivers received stress management training following randomization. The intervention occurred during the 100-day post-transplant period when caregivers are required. The training provided integrated cognitive behavioral strategies, psychoeducation, and problem-solving skills building as well as use of a biofeedback device. RESULTS Seventy percent of caregivers completed all eight sessions indicating good acceptability for the in-person intervention; however, most caregivers did not reliably use the biofeedback device. The most common reason for drop-out was their patient becoming gravely ill or patient death. Few caregivers dropped out because of study demands. The need for flexibility in providing intervention sessions was key to retention. CONCLUSION Our evidence-based stress management intervention for Allo-HSCT caregivers was feasible. Variability in acceptability and challenges in implementation are discussed and suggestions for refinement of the intervention are outlined. Dissemination efforts could improve by using alternative methods for providing caregiver support such as telephone or video chat to accommodate caregivers who are unable to attend in-person sessions.
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Affiliation(s)
- Teresa L Simoneau
- VA Eastern Colorado Healthcare System, 1020 Johnson Rd., Golden, CO, 80401, USA.
| | - Kristin Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Janet Spradley
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark L Laudenslager
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Abstract
This study examined whether sleep disturbance predicted or moderated responses to psychotherapy in participants who participated in STEP-BD, a national, multisite study that examined the effectiveness of different treatment combinations for bipolar disorder. Participants received either a brief psychosocial intervention called collaborative care (CC; n = 130) or intensive psychotherapy (IP; n = 163), with study-based pharmacotherapy. Participants (N = 243) were defined as current (past week) short sleepers (<6 hours/night), normal sleepers (6.5-8.5 hours/night), and long sleepers (≥9 hours/night), according to reported average nightly sleep duration the week before randomization. Sleep disturbances did not predict the likelihood of recovery nor time until recovery from a depressive episode. There was no difference in recovery rates between IP versus CC for normal sleepers, and medium effect sizes were observed for differences in short and long sleepers. In this study, sleep did not play a major role in predicting or moderating response to psychotherapy in bipolar disorder.
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Fountoulakis KN, Yatham L, Grunze H, Vieta E, Young A, Blier P, Kasper S, Moeller HJ. The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm. Int J Neuropsychopharmacol 2017; 20:121-179. [PMID: 27816941 PMCID: PMC5409012 DOI: 10.1093/ijnp/pyw100] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/29/2016] [Accepted: 11/03/2016] [Indexed: 02/05/2023] Open
Abstract
Background The current paper includes a systematic search of the literature, a detailed presentation of the results, and a grading of treatment options in terms of efficacy and tolerability/safety. Material and Methods The PRISMA method was used in the literature search with the combination of the words 'bipolar,' 'manic,' 'mania,' 'manic depression,' and 'manic depressive' with 'randomized,' and 'algorithms' with 'mania,' 'manic,' 'bipolar,' 'manic-depressive,' or 'manic depression.' Relevant web pages and review articles were also reviewed. Results The current report is based on the analysis of 57 guideline papers and 531 published papers related to RCTs, reviews, posthoc, or meta-analysis papers to March 25, 2016. The specific treatment options for acute mania, mixed episodes, acute bipolar depression, maintenance phase, psychotic and mixed features, anxiety, and rapid cycling were evaluated with regards to efficacy. Existing treatment guidelines were also reviewed. Finally, Tables reflecting efficacy and recommendation levels were created that led to the development of a precise algorithm that still has to prove its feasibility in everyday clinical practice. Conclusions A systematic literature search was conducted on the pharmacological treatment of bipolar disorder to identify all relevant random controlled trials pertaining to all aspects of bipolar disorder and graded the data according to a predetermined method to develop a precise treatment algorithm for management of various phases of bipolar disorder. It is important to note that the some of the recommendations in the treatment algorithm were based on the secondary outcome data from posthoc analyses.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Lakshmi Yatham
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Heinz Grunze
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Eduard Vieta
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Allan Young
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Pierre Blier
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Siegfried Kasper
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Hans Jurgen Moeller
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
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Ramírez A, Palacio JD, Vargas C, Díaz-Zuluaga AM, Duica K, Agudelo Berruecos Y, Ospina S, López-Jaramillo C. [Expressed Emotions, Burden and Family Functioning in Schizophrenic and Bipolar I Patients of a Multimodal Intervention Program: PRISMA]. REVISTA COLOMBIANA DE PSIQUIATRIA 2017; 46:2-11. [PMID: 28193369 DOI: 10.1016/j.rcp.2016.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/27/2015] [Accepted: 02/28/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Bipolar disorder and schizophrenia are causes of major suffering in patients. Nevertheless, they also affect family and caregiver functioning. This is important because the participation and involvement of families and caregivers is essential to achieve an optimal treatment. OBJECTIVE To describe the level of expressed emotions, burden, and family functioning of bipolar and schizophrenic patients and, to evaluate the efficacy of the multimodal intervention (MI) versus traditional intervention (TI) in family functioning and its perception by patients and caregivers. MATERIAL AND METHODS A prospective, longitudinal, therapeutic-comparative study was conducted with 302 patients (104 schizophrenic and 198 bipolar patients) who were randomly assigned to a MI or TI groups of a multimodal intervention program PRISMA. MI group received care from psychiatry, general medicine, neuropsychology, family therapy, and occupational therapy. TI group received care from psychiatry and general medicine. Hamilton, Young and SANS, SAPS scales were applied to bipolar and schizophrenic patients, respectively. The EEAG, FEICS, FACES III and ECF were also applied at the initial and final time. RESULTS There were statistically significant differences in socio- demographic and clinical variables in schizophrenia vs bipolar group: 83% vs 32.2% were male, 37 vs 43 mean age, 96% vs 59% were single, 50% vs 20% unemployed, and 20% vs 40% had college studies. In addition, 2 vs 2.5 numbers of hospitalisations, 18 vs 16 mean age of substance abuse onset and, 55 vs 80 points in EEAG. There were no statistically significant differences in family scales after conducting a multivariate analysis on thr initial and final time in both groups. CONCLUSIONS This study did not show changes in variables of burden and family functioning between bipolar and schizophrenic groups that were under TI vs MI.
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Affiliation(s)
- Alexandra Ramírez
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juan David Palacio
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Cristian Vargas
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Ana María Díaz-Zuluaga
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Kelly Duica
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Yuli Agudelo Berruecos
- Grupo de Epidemiología Hospitalaria, Hospital Universitario de San Vicente Fundación, Medellín, Colombia
| | - Sigifredo Ospina
- Grupo de Epidemiología Hospitalaria, Hospital Universitario de San Vicente Fundación, Medellín, Colombia
| | - Carlos López-Jaramillo
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
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Owen R, Gooding P, Dempsey R, Jones S. The Reciprocal Relationship between Bipolar Disorder and Social Interaction: A Qualitative Investigation. Clin Psychol Psychother 2016; 24:911-918. [PMID: 27862615 DOI: 10.1002/cpp.2055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence suggests that social support can influence relapse rates, functioning and various clinical outcomes in people with bipolar disorder. Yet 'social support' is a poorly defined construct, and the mechanisms by which it affects illness course in bipolar disorder remain largely unknown. Key aims of this study were to ascertain which facets of social interaction affect mood management in bipolar disorder, and how symptoms of bipolar disorder can influence the level of support received. METHOD Semi-structured qualitative interviews were conducted with 20 individuals with bipolar disorder. Questions were designed to elicit: the effects of social interaction upon the management and course of bipolar disorder; and the impact of bipolar disorder upon social relationships. An inductive thematic analysis was used to analyse the data. RESULTS Empathy and understanding from another person can make it easier to cope with bipolar disorder. Social interaction can also provide opportunities to challenge negative ruminative thoughts and prevent the onset of a major mood episode. The loss of social support, particularly through bereavement, creates a loss of control and can trigger mania or depression. Hypomanic symptoms can facilitate new social connections, whereas disinhibited and risky behaviour exhibited during mania can cause the breakdown of vital relationships. CONCLUSIONS An in-depth clinical formulation of an individual's perceptions of how their illness affects and is affected by social interaction is crucial to understanding psychosocial factors which influence mood management. These results have clear application in interventions which aim to promote improved wellbeing and social functioning in bipolar disorder. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONERS MESSAGES The relationship between bipolar-related experiences and social interaction is complex and multi-faceted. Bipolar disorder can damage social relationships and create a loss of social control via extreme mood states, but it can also offer a social advantage through elevated self-confidence during hypomania and enhanced resilience post-recovery. Positive social experiences can facilitate better personal coping and enhanced mood management, whilst negative social experiences can trigger the onset of acute mood episodes. A comprehensive formulation of the reciprocal links between facets of bipolar disorder and characteristics of interpersonal relationships should be used to guide psychosocial interventions that aim to enhance emotion regulation and improve functioning.
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Affiliation(s)
- Rebecca Owen
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Patricia Gooding
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Robert Dempsey
- Centre for Health Psychology, Staffordshire University, Stoke-on-Trent, UK
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
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Deckersbach T, Peters AT, Sylvia LG, Gold AK, da Silva Magalhaes PV, Henry DB, Frank E, Otto MW, Berk M, Dougherty DD, Nierenberg AA, Miklowitz DJ. A cluster analytic approach to identifying predictors and moderators of psychosocial treatment for bipolar depression: Results from STEP-BD. J Affect Disord 2016; 203:152-157. [PMID: 27289316 PMCID: PMC4976005 DOI: 10.1016/j.jad.2016.03.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/12/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND We sought to address how predictors and moderators of psychotherapy for bipolar depression - identified individually in prior analyses - can inform the development of a metric for prospectively classifying treatment outcome in intensive psychotherapy (IP) versus collaborative care (CC) adjunctive to pharmacotherapy in the Systematic Treatment Enhancement Program (STEP-BD) study. METHODS We conducted post-hoc analyses on 135 STEP-BD participants using cluster analysis to identify subsets of participants with similar clinical profiles and investigated this combined metric as a moderator and predictor of response to IP. We used agglomerative hierarchical cluster analyses and k-means clustering to determine the content of the clinical profiles. Logistic regression and Cox proportional hazard models were used to evaluate whether the resulting clusters predicted or moderated likelihood of recovery or time until recovery. RESULTS The cluster analysis yielded a two-cluster solution: 1) "less-recurrent/severe" and 2) "chronic/recurrent." Rates of recovery in IP were similar for less-recurrent/severe and chronic/recurrent participants. Less-recurrent/severe patients were more likely than chronic/recurrent patients to achieve recovery in CC (p=.040, OR=4.56). IP yielded a faster recovery for chronic/recurrent participants, whereas CC led to recovery sooner in the less-recurrent/severe cluster (p=.034, OR=2.62). LIMITATIONS Cluster analyses require list-wise deletion of cases with missing data so we were unable to conduct analyses on all STEP-BD participants. CONCLUSIONS A well-powered, parametric approach can distinguish patients based on illness history and provide clinicians with symptom profiles of patients that confer differential prognosis in CC vs. IP.
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Affiliation(s)
- Thilo Deckersbach
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | | | - Louisa G. Sylvia
- Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Michael Berk
- Deakin University, Melbourne, AU,University of Melbourne, Melbourne, AU
| | - Darin D. Dougherty
- Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
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Kallestad H, Wullum E, Scott J, Stiles TC, Morken G. The long-term outcomes of an effectiveness trial of group versus individual psychoeducation for bipolar disorders. J Affect Disord 2016; 202:32-8. [PMID: 27253214 DOI: 10.1016/j.jad.2016.05.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/13/2016] [Accepted: 05/21/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In this effectiveness trial we compared the long-term effects on hospitalizations of group psychoeducation (GP) versus individual psychoeducation (IP) for a heterogeneous sample of patients with BD recruited from general clinical settings. METHODS Eighty-five patients with BD were randomized to receive 10 weekly sessions of GP followed by 8 booster-sessions over the next two years, or three sessions of IP. Time to first admission over the course of GP was the primary outcome measure, with additional outcomes examining the use of psychiatric services over about 8 years. RESULTS Patients allocated to GP had longer survival time compared to IP over 27 months (p<0.05). There were also group differences in survival time over 8 years, but treatment allocation alone was no longer a significant predictor of survival time (p=0.07). There was an interaction between group (GP/IP) and harmful substance use (HSU), such that GP cases with comorbid HSU had the shortest survival time, whilst GP cases without HSU survived the longest (p=0.02). Also, GP cases had a small but significant reduction in hospital use compared with IP (p=0.04). LIMITATIONS We did not have a 'pure' treatment as usual group. Wide confidence intervals for some of the odds ratios suggest that the findings need to be treated with some caution. Insufficient sample size for more detailed subgroup analyses. CONCLUSIONS GP is superior to IP in delaying hospitalizations in a clinically representative population. However, GP did not prevent or delay admissions in BD patients with HSU.
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Affiliation(s)
- Håvard Kallestad
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Psychiatry, St. Olav's University Hospital, Trondheim, Norway.
| | - Elin Wullum
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Helgeland Hospital Trust, Mo i Rana, Norway
| | - Jan Scott
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Academic Psychiatry, Institute of Neuroscience, University of Newcastle, Newcastle Upon Tyne, UK
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Gunnar Morken
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Psychiatry, St. Olav's University Hospital, Trondheim, Norway
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Pfennig A, Conell J, Ritter P, Ritter D, Severus E, Meyer TD, Hautzinger M, Wolff J, Godemann F, Reif A, Bauer M. Leitliniengerechte psychiatrisch-psychotherapeutische Behandlung bei bipolaren Störungen. DER NERVENARZT 2016; 88:222-233. [PMID: 27220643 DOI: 10.1007/s00115-016-0083-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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MacDonald L, Chapman S, Syrett M, Bowskill R, Horne R. Improving medication adherence in bipolar disorder: A systematic review and meta-analysis of 30 years of intervention trials. J Affect Disord 2016; 194:202-21. [PMID: 26851552 DOI: 10.1016/j.jad.2016.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 11/27/2015] [Accepted: 01/04/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Medication non-adherence in bipolar disorder is a significant problem resulting in increased morbidity, hospitalisation and suicide. Interventions to enhance adherence exist but it is not clear how effective they are, or what works and why. METHODS We systematically searched bibliographic databases for RCTs of interventions to support adherence to medication in bipolar disorder. Study selection and data extraction was performed by two investigators. Data was extracted on intervention design and delivery, study characteristics, adherence outcomes and study quality. The meta-analysis used pooled odds ratios for adherence using random effects models. RESULTS Searches identified 795 studies, of which 24 met the inclusion criteria, 18 provided sufficient data for meta-analysis. The pooled OR was 2.27 (95% CI 1.45-3.56) equivalent to a two-fold increase in the odds of adherence in the intervention group relative to control. Smaller effects were seen where the control group consisted of an active comparison and with increasing intervention length. The effects were robust across other factors of intervention and study design and delivery. LIMITATIONS Many studies did not report sufficient information to classify intervention design and delivery or judge quality and the interventions were highly variable. Therefore, the scope of moderation analysis was limited. CONCLUSIONS Even brief interventions can improve medication adherence. Limitations in intervention and study design and reporting prevented assessment of which elements of adherence support are most effective. Applying published guidance and quality criteria for designing and reporting adherence interventions is a priority to inform the implementation of cost-effective adherence support.
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Affiliation(s)
| | - Sarah Chapman
- Centre for Behavioural Medicine, UCL School of Pharmacy, UK
| | - Michel Syrett
- The Roffey Park Institute & Lancaster University (Spectrum Centre for Mental Health Research), UK
| | - Richard Bowskill
- Brighton and Sussex Medical School, UK & Sussex Partnership NHS Foundation Trust, UK
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, UK.
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Stange JP, Sylvia LG, da Silva Magalhães PV, Miklowitz DJ, Otto MW, Frank E, Yim C, Berk M, Dougherty DD, Nierenberg AA, Deckersbach T. Affective instability and the course of bipolar depression: results from the STEP-BD randomised controlled trial of psychosocial treatment. Br J Psychiatry 2016; 208:352-8. [PMID: 26795426 PMCID: PMC4816971 DOI: 10.1192/bjp.bp.114.162073] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/29/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about predictors of recovery from bipolar depression. AIMS We investigated affective instability (a pattern of frequent and large mood shifts over time) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychosocial treatment for acute depression. METHOD A total of 252 out-patients with DSM-IV bipolar I or II disorder and who were depressed enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and were randomised to one of three types of intensive psychotherapy for depression (n= 141) or a brief psychoeducational intervention (n= 111). All analyses were by intention-to-treat. RESULTS Degree of instability of symptoms of depression and mania predicted a lower likelihood of recovery and longer time until recovery, independent of the concurrent effects of symptom severity. Affective instability did not moderate the effects of psychosocial treatment on recovery from depression. CONCLUSIONS Affective instability may be a clinically relevant characteristic that influences the course of bipolar depression.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Thilo Deckersbach
- Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Oud M, Mayo-Wilson E, Braidwood R, Schulte P, Jones SH, Morriss R, Kupka R, Cuijpers P, Kendall T. Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis. Br J Psychiatry 2016; 208:213-22. [PMID: 26932483 DOI: 10.1192/bjp.bp.114.157123] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psychological interventions may be beneficial in bipolar disorder. AIMS To evaluate the efficacy of psychological interventions for adults with bipolar disorder. METHOD A systematic review of randomised controlled trials was conducted. Outcomes were meta-analysed using RevMan and confidence assessed using the GRADE method. RESULTS We included 55 trials with 6010 participants. Moderate-quality evidence associated individual psychological interventions with reduced relapses at post-treatment (risk ratio (RR) = 0.66, 95% CI 0.48-0.92) and follow-up (RR = 0.74, 95% CI 0.63-0.87), and collaborative care with a reduction in hospital admissions (RR = 0.68, 95% CI 0.49-0.94). Low-quality evidence associated group interventions with fewer depression relapses at post-treatment and follow-up, and family psychoeducation with reduced symptoms of depression and mania. CONCLUSIONS There is evidence that psychological interventions are effective for people with bipolar disorder. Much of the evidence was of low or very low quality thereby limiting our conclusions. Further research should identify the most effective (and cost-effective) interventions for each phase of this disorder.
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Affiliation(s)
- Matthijs Oud
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Evan Mayo-Wilson
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Ruth Braidwood
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Peter Schulte
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Steven H Jones
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Richard Morriss
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Ralph Kupka
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Pim Cuijpers
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Tim Kendall
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
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Reinares M, Bonnín C, Hidalgo-Mazzei D, Sánchez-Moreno J, Colom F, Vieta E. The role of family interventions in bipolar disorder: A systematic review. Clin Psychol Rev 2016; 43:47-57. [DOI: 10.1016/j.cpr.2015.11.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/01/2015] [Accepted: 11/09/2015] [Indexed: 12/19/2022]
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Carol EE, Mittal VA. Resting cortisol level, self-concept, and putative familial environment in adolescents at ultra high-risk for psychotic disorders. Psychoneuroendocrinology 2015; 57:26-36. [PMID: 25880698 PMCID: PMC4437835 DOI: 10.1016/j.psyneuen.2015.03.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 12/24/2022]
Abstract
A growing body of evidence suggests that resting cortisol levels are elevated in patients with schizophrenia and closely tied to symptom severity. However, there is limited research on the biological stress system during the ultra high-risk (UHR) period immediately preceding the onset of psychosis, and cortisol has not been examined in relation to individual characteristics such as self-concept or potential stressors such as putative familial environment in this critical population. In the present study, salivary cortisol samples were collected on 37 UHR and 42 matched control adolescents, and these individuals were assessed with clinical interviews as well as a measure of self-concept. For a subsection of the sample (23 UHR and 20 control adolescents), a participating relative/caretaker was also assessed with an expressed emotion interview designed to gauge psychosocial environment. Consistent with previous studies, UHR participants exhibited elevated resting cortisol levels when compared with controls. In addition, UHR adolescents exhibited increased negative self-concept and their relatives/caretakers endorsed significantly fewer initial positive statements about the participant. Interestingly, a strong trend in the UHR group suggests that higher cortisol levels are associated with higher rates of critical statements from relatives/caretakers. Furthermore, elevated cortisol levels in the participants were associated with increased negative self-concept as well as fewer initial positive comments from relatives/caretakers. Results suggest that hypothalamic-pituitary-adrenal axis (HPA) dysfunction is closely associated with both individual and environmental-level characteristics. Taken together, these findings support a neural diathesis-stress model of psychosis and future studies, designed to examine causal relationships, stand to inform both our understanding of pathogenic processes in the high-risk period as well as early intervention efforts.
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Affiliation(s)
- Emily E. Carol
- University of Colorado Boulder Department of Psychology and Neuroscience Boulder, Colorado, 80309 United States of America,Corresponding Author: Emily E. Carol University of Colorado at Boulder Department of Psychology and Neuroscience, Center for Neuroscience 345 UCB Boulder, CO 80309-0345 Phone: 303.492-4616
| | - Vijay A. Mittal
- Northwestern University, Department of Psychology, Evanston, IL, 60208, USA
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Abstract
Several reasons justify the need for nonpharmacological interventions for bipolar disorder (BD) in women. This review focuses on psychosocial therapies for BDs in women. The research evidence for a wide range of psychosocial interventions for the management of BDs in women has been presented. All the interventions have some common components like targeting disease management, information regarding illness, and coping skills. There also are distinctive features like cognitive restructuring and self-rated mood charts in cognitive behavior therapy, regulation of sleep/wake cycles and daily routines in interpersonal sleep regulation therapy, and communication skill training in family treatments. Many psychosocial interventions hold promise as adjunctive therapies for bipolar patients. In India, there is a considerable dearth of literature in this area due lack of skilled staff for psychosocial interventions. Future trials need to: Clarify which populations are most likely to benefit from which strategies; identify putative mechanisms of action; systematically evaluate costs, benefits, and generalizability of effects, and record adverse effects.
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Affiliation(s)
- Sujit Kumar Naik
- Department of Psychiatry, Chhattisgarh Institute of Medical Sciences, Bilaspur, Chhattisgarh, India
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Owen R, Gooding P, Dempsey R, Jones S. A qualitative investigation into the relationships between social factors and suicidal thoughts and acts experienced by people with a bipolar disorder diagnosis. J Affect Disord 2015; 176:133-40. [PMID: 25706607 DOI: 10.1016/j.jad.2015.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence rate of completed suicide in bipolar disorder is estimated to be as high as 19%. Social factors or influences, such as stigmatisation and family conflict, contribute to the development of suicidal ideation in clinical and non-clinical populations. Yet, there is a lack of studies examining suicidality from a psychosocial perspective in people who experience bipolar disorder. METHOD Semi-structured interviews were used to collect qualitative data from 20 participants with bipolar disorder. The interview focused on the effects of social factors upon participants׳ experiences of suicidality (suicidal thoughts, feelings or behaviours). A thematic analysis was used to understand the data. RESULTS Social or interpersonal factors which participants identified as protective against suicidality included, 'the impact of suicide on others' and, 'reflecting on positive social experiences'. Social factors which triggered suicidal thoughts included, 'negative social experiences' and, 'not being understood or acknowledged'. Social factors which worsened suicidal thoughts or facilitated suicidal behaviour were, 'feeling burdensome,' and 'reinforcing negative self-appraisals'. LIMITATIONS Some participants had not experienced suicidal thoughts for many years and were recalling experiences which had taken place over ten years ago. The accuracy and reliability of these memories must therefore be taken into consideration when interpreting the results. CONCLUSIONS The themes help to enhance current understanding of the ways in which social factors affect suicidality in people who experience bipolar disorder. These results highlight the importance of considering the social context in which suicidality is experienced and incorporating strategies to buffer against the effects of negative social experiences in psychological interventions which target suicide risk in bipolar disorder.
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Affiliation(s)
- Rebecca Owen
- School of Psychological Sciences, University of Manchester, UK.
| | | | - Robert Dempsey
- Centre for Health Psychology, Staffordshire University, UK
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Lancaster University, UK
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Klaus NM, Algorta GP, Young AS, Fristad MA. Validity of the Expressed Emotion Adjective Checklist (EEAC) in Caregivers of Children with Mood Disorders. COUPLE & FAMILY PSYCHOLOGY 2015; 4:27-38. [PMID: 25729632 PMCID: PMC4339054 DOI: 10.1037/cfp0000036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Expressed Emotion (EE; criticism/hostility and emotional overinvolvement) displayed in family interactions has been associated with the presence and poorer course of multiple disorders in adults and children. As such, validating appropriate tools for measuring EE could have important implications for research and clinical practice. Child EE measures are limited though there are some established methods of assessing EE in adults. The Expressed Emotion Adjective Checklist (EEAC), a self-report measure of EE, has demonstrated validity with adults but has not been evaluated in child samples. The present study examined reliability, stability, and validity of the EEAC in measuring EE in caregivers of children with mood disorders. EEAC scores were associated with the criticism component of the Five Minute Speech Sample (FMSS), a commonly used EE measure in children. EEAC scores were also stable and predicted manic symptom severity and global impairment one year later. These data suggest the EEAC may be a useful self-report measure of EE in children.
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Efficacy of psychoeducational family intervention for bipolar I disorder: A controlled, multicentric, real-world study. J Affect Disord 2015; 172:291-9. [PMID: 25451428 DOI: 10.1016/j.jad.2014.10.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 10/10/2014] [Accepted: 10/11/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study assessed the efficacy of the Falloon model of psychoeducational family intervention (PFI), originally developed for schizophrenia management and adapted to bipolar I disorder. The efficacy of the intervention was evaluated in terms of improvement of patients׳ social functioning and reduction of family burden. METHODS This was a multicentre, real-world, controlled, outpatient trial carried out in 11 randomly recruited Italian mental health centres. Enroled patients and key-relatives were consecutively allocated either to receive PFI and Treatment As Usual (TAU) or to a waiting list receiving TAU alone. The efficacy of the intervention was evaluated in terms of improvement in patients׳ social functioning (primary outcome) and reduction of family burden (secondary outcome). RESULTS Of the 137 recruited families, 70 were allocated to the experimental group and 67 to the control group. At the end of the intervention, significant improvements in patients׳ social functioning and in relatives׳ burden were found in the treated group compared to TAU. This effect of the intervention remained also after controlling for several confounding patient׳s socio-demographic and clinical factors. The experimental intervention had an impact also on other outcome measures, such as patients׳ clinical status and personal burden. LIMITATIONS Lack of an active control group. CONCLUSIONS The results of this study clearly show that the psychoeducational family intervention according to the Falloon model is effective in improving the social outcome of patients with bipolar I disorder.
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Miziou S, Tsitsipa E, Moysidou S, Karavelas V, Dimelis D, Polyzoidou V, Fountoulakis KN. Psychosocial treatment and interventions for bipolar disorder: a systematic review. Ann Gen Psychiatry 2015; 14:19. [PMID: 26155299 PMCID: PMC4493813 DOI: 10.1186/s12991-015-0057-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/29/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic disorder with a high relapse rate, significant general disability and burden and with a psychosocial impairment that often persists despite pharmacotherapy. This indicates the need for effective and affordable adjunctive psychosocial interventions, tailored to the individual patient. Several psychotherapeutic techniques have tried to fill this gap, but which intervention is suitable for each patient remains unknown and it depends on the phase of the illness. METHODS The papers were located with searches in PubMed/MEDLINE through May 1st 2015 with a combination of key words. The review followed the recommendations of the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses statement. RESULTS The search returned 7,332 papers; after the deletion of duplicates, 6,124 remained and eventually 78 were included for the analysis. The literature supports the usefulness only of psychoeducation for the relapse prevention of mood episodes and only in a selected subgroup of patients at an early stage of the disease who have very good, if not complete remission, of the acute episode. Cognitive-behavioural therapy and interpersonal and social rhythms therapy could have some beneficial effect during the acute phase, but more data are needed. Mindfulness interventions could only decrease anxiety, while interventions to improve neurocognition seem to be rather ineffective. Family intervention seems to have benefits mainly for caregivers, but it is uncertain whether they have an effect on patient outcomes. CONCLUSION The current review suggests that the literature supports the usefulness only of specific psychosocial interventions targeting specific aspects of BD in selected subgroups of patients.
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Affiliation(s)
- Stella Miziou
- Aristotle University of Thessaloniki, Thessaloníki, Greece
| | | | | | - Vangelis Karavelas
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos Street (1st Parodos, Ampelonon Str.), Pournari Pylaia, 55535 Thessaloníki, Greece
| | - Dimos Dimelis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos Street (1st Parodos, Ampelonon Str.), Pournari Pylaia, 55535 Thessaloníki, Greece
| | | | - Konstantinos N Fountoulakis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos Street (1st Parodos, Ampelonon Str.), Pournari Pylaia, 55535 Thessaloníki, Greece
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